A Doctor’s Dark Year

By Dhruv Khullar, a contributing writer at The New Yorker, is a practicing physician and an assistant professor at Weill Cornell Medical College.

“Dad, you have to stay away,” she said.

Dale and Athena took Knox and Tinsley into one of the airport’s family restrooms, removed their clothes, and scrubbed their bodies with wipes. They dressed their grandchildren in pajamas and put their travel clothes in a separate bag. When their daughter came into the room, to retrieve something from the kids’ luggage, she looked dazed. “She had no emotion,” Athena recalled. “She was so matter-of-fact. I could tell she was compartmentalizing. It was just ‘This is the task at hand. This is what I need to do.’ ”

Out in the terminal, Bankhead-Kendall waved goodbye from a distance and turned to walk to her gate. She knew that some doctors had been killed by the coronavirus; as she boarded the flight back to Boston, she didn’t know whether she would see her children again.

In normal times, some ten to twenty per cent of patients admitted to an I.C.U. go on to die. In the spring of 2020, the COVID-19 mortality rate for patients requiring I.C.U.-level care approached fifty per cent. For Bankhead-Kendall, the carnage felt suffocating and endless; it was aggravated by the cruel fact that most patients died alone. Each day, orderlies brought metal gurneys to the I.C.U. to carry the bodies out. They sometimes hesitated, double-checking to make sure that they’d come to the right room—there had been so many deaths that it was hard to keep track. Months later, the sight of a gurney would trigger paralyzing flashbacks for Bankhead-Kendall. At the time, they mainly made her feel inept. “Nothing I did ever felt like it was enough,” she said. “We were supposed to be good at getting people better. Instead, we got good at dealing with dead bodies.”

These feelings of inadequacy were exacerbated by the uncertainties of treating COVID-19. Often, medical professionals had to draw on speculation and anecdotes in making clinical decisions. “It was, like, ‘We’re going to drop you off in enemy territory, but we don’t actually know how to fight them, so, good luck!’ ” Bankhead-Kendall said. She joined a WhatsApp group in which physicians from around the world—China, Italy, France—shared their clinical experiences. She scrolled through increasingly ominous messages: F.Y.I., we’re seeing random bowel perforations when people are really sick; F.Y.I., we’re seeing fatal arrhythmias after patients get better.

On Easter Sunday, she worked another overnight shift. Among her patients was a woman in her fifties who was experiencing many of the most serious COVID-19 complications: blood clots, heart damage, kidney failure. She’d been on a ventilator for weeks, and there was little indication that she would recover; her family had decided that prolonging her life would only prolong her suffering. It fell to Bankhead-Kendall to call the woman’s husband and discuss the process for withdrawing care. The man told her that he himself had chronic medical problems and couldn’t come in. Bankhead-Kendall promised him that she would stay with his wife after the breathing tube was removed.

In the evening hours, the woman faded in and out of consciousness, and Bankhead-Kendall held her hand. She spoke aloud the names of her family members, and told her that they loved her. She took out her phone, opened the Pandora app, selected a Frank Sinatra station, and placed it in a ziplock bag near her head.

She looked through the window, into the hall. Outside the room, nurses held up signs containing lab results for other critically ill patients and queries about their ventilator settings. Bankhead-Kendall mimed answers to their queries.

Around midnight, the woman’s heart rate became erratic and slow. Bankhead-Kendall listened as, through the phone’s speakers, “Over the Rainbow” started to play. The woman’s heart stopped; she took her last breath. Bankhead-Kendall turned to look at the clock and pronounce the time of death.

After sending their kids to Texas, Brittany and Brian told their colleagues that they could pick up more shifts. If they were going to be apart from their children, they wanted to make the most of it. They’d hoped that the separation would last a few weeks, but, as the weather warmed, it became clear that a reunion was far off. The surge was unrelenting—hospitals were so full that patients were sometimes treated on stretchers in hallways. After a long shift on her birthday, in late April, Bankhead-Kendall came home and propped her phone up against a bowl of avocados on the kitchen island; as the kids watched over FaceTime, she blew out some candles. As a trainee, Brittany had less control over her time than Brian did. In the time that she did have off, she had trouble disengaging. Brian noticed her mood darken. “She would come home and tell me these horrific stories, day after day,” he recalled. “I’d try to pull her back a bit. I’d say, ‘You have to maintain some sort of boundary. There’s such a thing as being too invested.’ ”

In Texas, on a chalkboard on his grandparents’ refrigerator, Knox started keeping a tally of the number of days since he’d seen his parents. On some evenings, he and Brian would play Battleship over FaceTime and chat about the day’s activities, which for Knox might have included a hike, a picnic, or a bike ride. Occasionally, Brittany’s sisters would stop by with their kids, so that Knox and Tinsley could play with other children. Knox missed his parents, but mostly managed. Tinsley, who was two, had a harder time. She was confused by the separation. She grew withdrawn and angry; she started having more tantrums. When Brittany and Brian read to her over FaceTime, she would push the phone away; after they’d hung up, she would ask for them. One day, when Athena was changing Tinsley’s diaper, the girl saw a photo of her parents on a nearby wall. “She just started wailing and wailing,” Athena said. “It was devastating. I thought, No baby should have to be away from her parents like this. It’s not right. But what choice did we have?”

In June, in Boston, the pace began to slow. Infections fell across the Northeast, and some of the makeshift I.C.U.s at Mass General were dismantled. But Bankhead-Kendall was still seeing COVID-19 patients, and her nightmares continued. In dreams, she sprinted toward their rooms only to arrive too late; she stared at them through windows as they gasped for air over the sounds of alarms and ventilators. She saw herself separated from her children forever. One afternoon, after rounds, while finishing her notes in a workroom, she started to cough—a guttural, productive cough that wouldn’t stop. She gathered her things, rushed to the employee clinic, and got tested for the coronavirus. The test ultimately came back negative, but she still had to self-isolate.

That would be her last shift in Boston: by the time she was out of quarantine, her fellowship—a one-year program, beginning and ending in July—was over. The previous year, she’d accepted a faculty position at Texas Tech University, in Lubbock; Brian had moved there in May, to start his own faculty job and work as an emergency-room physician. Now Brittany packed up the last of their things and followed. When she landed in Lubbock, Knox raced across the terminal and jumped into her arms. Tinsley, however, held back. “As a mom, it was heartbreaking,” Bankhead-Kendall told me. “It felt like she’d forgotten who I was.” As they walked through the airport, Tinsley started talking. “I realized how much she’d changed,” Bankhead-Kendall said. “I realized how much I’d missed.”

“Before, it was, ‘I can’t do my job and be a good mom,’ ” Bankhead-Kendall said. “Now it was, ‘I can’t do my job and deal with P.T.S.D.’ ”

In Lubbock, the coronavirus case rate was lower, and the hospital ran more or less normally. Bankhead-Kendall returned to the operating room. The work was intense: during a typical shift, she might see thirty new patients and operate on five or ten. Most of her patients had suffered serious physical trauma—a motorcycle accident, a gunshot wound; previously healthy, they depended on emergency surgery to survive. “That’s my jam,” Bankhead-Kendall said. “I was riding high.” When she had a spare moment, she would pop down to see Brian in the emergency department.

Still, she noticed something unsettling. Increasingly, people who were rushed to the hospital after acute trauma were found to be infected with the coronavirus. This could only be a sign of rampant community spread. Bankhead-Kendall realized that she’d ridden the wave from Boston to Lubbock. Within a few weeks, coronavirus cases exploded. The hospital began facing familiar shortages of space, and erected tents in the parking lot to manage the flow of patients; it converted some of its pediatric I.C.U.s into COVID-19 units. Rooms with kids’ puzzles on shelves and colorful paintings on the walls were now filled with ventilators and gurneys. This can’t be happening again, Bankhead-Kendall thought.

She found that, whenever she pushed through the doors of the I.C.U., her heart started racing. Her palms grew clammy; her eyes glazed over; she felt a heat rise in her chest and a knot form in her gut. Sometimes, she experienced a gripping, foreboding anxiety, or a vague detachment from the present. Occasionally, she felt paralyzed—unable to move or think clearly. “I kept thinking, Focus on the patient in front of you. Don’t get COVID. Don’t die,” she said. At home, she was reunited with her kids, but Brian noticed that she was becoming more withdrawn. “You could tell she was secluded in her own head,” he said. “No matter what I did, there was this huge wall up. I told her we needed to get her help. We needed to do something.”

Critically ill patients continued to flow into the hospital; Bankhead-Kendall was the last person many of them saw. She began to feel that, no matter what she did, she couldn’t escape COVID-19. “It followed her wherever she went,” Brian said. “Talk about P.T.S.D. I mean, what a nightmare scenario. You’re not only being triggered, you’re actually having to relive each moment.” Several times, she considered quitting. “She would say, ‘I can’t go to work today, I literally cannot do it,’ ” Brian said. “Then, somehow, she found the strength to go on.”

One night in late September, Bankhead-Kendall was called to the bedside of a coronavirus patient whose lungs were filling with blood. On a screen, a monitor traced his rising heart rate and falling oxygen levels; over the din of the I.C.U., the ventilator alarm pinged. Standing gloved, gowned, and masked in Lubbock, she was suddenly overcome by a vision of a near-identical situation in Boston. She saw a Boston nurse through a window. The nurse was inside a patient’s room, screaming for help as the patient drowned in his own blood. She saw herself reach for a gown and an N95 respirator. She went into the room. She snaked a bronchoscope into the man’s airway, in search of the source of the bleeding, as he gagged and coughed, expelling virus into the air. Then she noticed that she’d put her N95 on incorrectly. The mask hadn’t sealed to her face; there was a hole near the left side of her mouth. While she watched, the man died.

“I was losing it with these flashbacks,” she said. “Before, it was, ‘I can’t do my job and be a good mom.’ Now it was, ‘I can’t do my job and deal with P.T.S.D.’ ” For a few days, she worked to suppress the visions; she willed herself to stave off intrusive thoughts. At first, it seemed to work. But, over time, she started to feel numb. “Things I used to dread, I didn’t anymore,” she said. “I knew it wasn’t healthy. I’d think, Do I really need P.P.E.? Does it really matter what I do or don’t do? That’s when I knew I was losing control.”

In early October, Bankhead-Kendall sat in her car after an especially draining shift. A patient she’d operated on—someone without COVID—had suffered a terrible complication and died. She turned the key and started to drive. She thought about what she could have done differently: Used a different surgical technique? Begun the operation sooner? As she approached home, she had a thought that scared her: she wondered whether it would be better if she weren’t around anymore.

The next day, she met with the chair of her department and told her that she needed time away. She’d scheduled a few days off the following month, but the chair encouraged her to meet with a therapist immediately. The therapist told her that she needed to confront the pain she’d experienced during the pandemic—that she needed to cry. So she sat in her office, her car, her home, and cried. “It was an affirmation that everything that’s happened is not O.K.,” Bankhead-Kendall said. “None of it is O.K. I grieved for the time I didn’t get with my kids. When other parents clung to their kids, I sent mine away. I grieved for my mental and emotional well-being. I grieved for the families who’d lost loved ones. I grieved for my patients and how they spent their last moments on earth.”